Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

Fear of losing their jobs contributes to surgeons' reluctance to get mental health treatment, according to the study. Nearly 8,000 surgeons participated.

About 6 percent reported recent suicidal thoughts; the rate was 16 percent among those who'd made a recent major medical error although it wasn't known if that was the reason.

Only about one-fourth of those with suicidal thoughts said they'd sought professional mental health. By contrast, among the general population, about 3 percent have suicidal thoughts and 44 percent of them seek mental health treatment, other studies have shown.

"Surgeons reported a great deal of concern about potential repercussions for their license to practice medicine," and many admitted self-medicating with antidepressant drugs, said lead author Dr. Tait Shanafelt of the Mayo Clinic.

Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

Arkansas Dr. Robert Lehmberg, 63, said it took prodding from close friends to finally get him to seek treatment for depression and suicidal thoughts several years ago. Though he feared losing his license and being stigmatized, neither happened, and he said medication and psychotherapy have greatly helped.

Working 60 to 80 hours weekly in a busy Little Rock, Ark. plastic surgery office contributed to his depression, but Lehmberg said he was careful to avoid medical errors.

"Surgeons are taught that the patient is their responsibility, period. So absolutely, if something goes wrong, the surgeons I know take it very personally," Lehmberg said. He was not involved in the study. Lehmberg now works in palliative care, helping ease suffering in dying patients.

The study appears in the January issue of Archives of Surgery. It was commissioned by the American College of Surgeons and surveyed members of that group by e-mail. Answers were anonymous.

Surgeons were questioned about whether they'd had suicidal thoughts within the past year. They weren't asked about suicide attempts but the authors said as many as 50 percent of people who think about suicide also make an attempt.

The research didn't address specific reasons why they had contemplated suicide but strongly suggests depression, job burnout and medical errors were contributing factors. To a lesser extent, being unmarried, divorced and childless also were linked with contemplating suicide. Other factors also could have contributed to a risk for suicidal thoughts.

Results published previously from the same survey showed almost 9 percent of participating surgeons said they'd made a recent major medical error. Overall, surgeons queried worked 60 hours per week on average; 40 percent felt burned out; and 30 percent had symptoms of depression. Most said their work left little time for personal and family life.

Few who worked less than 40 hours weekly had suicidal thoughts.

Editorial authors Kelly McCoy and Sally Carty, both surgeons at the University of Pittsburgh's medical school, said these issues are too often ignored.

Surgeons work long, irregular hours in an environment that honors self-denial, prizes resilience, "and tends to interpret imperfection as failure," they said.

The survey only queried surgeons so it is not known if they have a higher rate of suicidal tendencies than other doctors.

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